HEALTH INFORMATION

Lymph Node Biopsy

Test Overview

A lymph node
biopsy removes lymph node tissue to be looked at under a microscope
for signs of infection or a disease, such as cancer. Other tests may also be
used to check the lymph tissue sample, including a
culture, genetic tests, or tests to study the body's
immune system (immunological tests).

Lymph nodes are part of the immune system. They are found in the neck,
behind the ears, in the armpits, and in the chest, belly, and groin.

Lymph nodes in healthy people are usually hard to
feel. But lymph nodes in the neck, armpit, or groin can get bigger and become
tender. Swollen lymph nodes usually mean an infection. But the swelling can
also be caused by a cut, scratch, insect bite, tattoo, drug reaction, or
cancer.

There are several ways to do a lymph node biopsy. The
lymph node sample will be looked at under a microscope for problems.

Fine-needle aspiration biopsy. Your doctor inserts a thin needle into a lymph node and removes a sample of cells.

Core needle biopsy. Your doctor inserts a needle with a special tip and removes a sample of tissue about the size of a grain of rice.

Open (surgical) biopsy. Your doctor will make a small cut in the skin and remove a lymph node. If more than one lymph node is taken, the biopsy is called a lymph
node dissection. Open biopsy and lymph node dissection let your doctor take a
bigger sample than a needle biopsy.

Why It Is Done

Lymph node biopsy is done to:

Check the cause of enlarged lymph nodes that do
not return to normal size on their own.

Check the cause of
symptoms, such as an ongoing fever, night sweats, or weight
loss.

Check to see if a known cancer has spread to the lymph nodes.
This is called staging and is done to plan cancer treatment.

Remove
cancer.

How To Prepare

Tell your doctor if you:

Are taking any medicines or supplements (such as vitamins or herbal remedies).

Have any bleeding problems or take blood thinners, such as
warfarin (Coumadin) or
clopidogrel (Plavix).

Are or might be pregnant.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your
doctor about any concerns you have regarding the need for the biopsy, its
risks, how it will be done, or what the results will mean. To help you
understand the importance of the biopsy, fill out the
medical test information form(What is a PDF document?).

If you take a blood thinner, you will
probably need to stop taking it for a week before the biopsy.

If a
lymph node biopsy will be done under
local anesthesia, you do not need to do anything else
to prepare for the biopsy.

If the biopsy will be done under
general anesthesia, follow the instructions exactly
about when to stop eating and drinking, or your surgery may be canceled. If
your doctor has instructed you to take your medicines on the day of surgery, do
so using only a sip of water. An
intravenous line (IV) will be put in your arm, and a
sedative medicine will be given before the biopsy.
Arrange for someone to drive you home if you are going to have general
anesthesia or will be given a sedative.

Other tests, such as blood
tests or
X-rays, may be done before the lymph node
biopsy.

How It Is Done

Fine-needle aspiration biopsy

A needle biopsy of a
lymph node near the skin is usually done by a
hematologist, a
radiologist, or a
general surgeon. A needle biopsy of a lymph node
deeper within the body is usually done by a radiologist using a
CT scan or
ultrasound to help guide the needle. The biopsy may be
done in a surgery clinic or the hospital.

You may need to take
off all or some of your clothes. If needed, you will be given a cloth or paper covering to use during the biopsy.

Your doctor numbs the area where the needle will be inserted. Once the area is numb, the
needle is put through the skin and into the lymph node. You must lie still while the
biopsy is done. The biopsy sample is
sent to a lab to be looked at under a microscope.

The needle is then removed. Pressure is put on the
needle site to stop any bleeding. A bandage is put on. A fine-needle aspiration
biopsy takes about 5 to 15 minutes.

Core needle biopsy

You may need to take
off all or some of your clothes. If needed, you will be given a cloth or paper covering to use during the biopsy.

Your doctor numbs the area where the needle will be inserted. Once the area is numb, a small
cut is made in the skin. A needle with a special tip is put through the skin
and into the lymph node. You must lie still while the biopsy is done.

The needle is then removed. Pressure is put on the needle site to stop
any bleeding. A bandage is put on. A core needle biopsy takes about 20
minutes.

Open biopsy and lymph node dissection

An open
biopsy of a lymph node is done by a surgeon. For a lymph node near the surface
of the skin, the biopsy site is numbed with local anesthetic. For a lymph node
deeper in the body or for lymph node dissection, you may have general
anesthesia.

You may need to take
off all or some of your clothes. If needed, you will be given a cloth or paper covering to use during the biopsy.

You will lie on
an examination table and your body will be positioned to allow the doctor to take the biopsy sample. The skin over the biopsy site will be cleaned with a
special soap. The area is covered with a sterile sheet. A small cut will be
made so the whole lymph node or a slice of it can be taken out.

Stitches are used to close the skin, and a bandage is put on. You will be
taken to a recovery room until you are fully awake. You can usually return to
your normal activities the next day.

An open biopsy usually takes
from 30 to 60 minutes. If you have had a lymph node dissection to remove
cancer, the surgery may take longer.

How It Feels

You will feel only a quick sting from
the needle if you have a local anesthesia to numb the biopsy area. You may feel
some pressure when the biopsy needle is put in. After a fine-needle aspiration
biopsy or core needle biopsy, the site may be tender for 2 to 3 days. You also
may have a bruise around the site.

If you have general anesthesia
for an open lymph node biopsy, you will not be awake during the biopsy. After
you wake up, the area may be numb from a local anesthetic that was put into the
biopsy site. You will also feel sleepy for several hours.

For 1 to
2 days after an open lymph node biopsy, you may feel tired. You may also have a
mild sore throat if a tube was used to help you breathe during the biopsy.
Using throat lozenges and gargling with warm salt water may help with the sore
throat.

After an open biopsy, the area may feel tender, firm,
swollen, and bruised. Fluid may collect near the biopsy site. Fluid may
also leak from the biopsy site. You can use an ice pack or take an over-the-counter pain medicine (not aspirin) to help relieve swelling and mild pain. The tenderness should go away in
about a week, and the bruising usually fades within 2 weeks. But the firmness
and swelling may last for 6 to 8 weeks. Do not do any heavy lifting or other
activities that stretch or pull the muscles around the area.

Risks

There is a chance of an infection at the biopsy
site. An infection can be treated with
antibiotics.

Call your doctor immediately
if:

Your pain lasts longer than a
week.

You have redness, a lot of swelling, bleeding, or pus from
the biopsy site.

You have a fever.

There is fluid buildup in the area where the lymph node was taken
out. This occurs most often when removing the lymph nodes that run in a line
from under the arm to the collarbone (axillary lymph nodes). This can happen
immediately after surgery or even months or years later. Most people who have a
lymph node biopsy do not have a problem with fluid
buildup.

You have numbness in the skin near the biopsy site. This may be
caused by nerve damage.

Results

A lymph node
biopsy removes
lymph node tissue to be looked at under a microscope
for signs of infection or a disease, such as cancer. Test results from a lymph
node biopsy are usually available within a few days. Finding some types of
infections may take longer.

The lymph node sample is usually
treated with special dyes (stains) that color the cells and make problems more
visible.

Lymph node biopsy

Normal:

The lymph node has normal numbers of lymph
node cells.

The structure of the lymph node and the
appearance of the cells in it are normal.

What Affects the Test

A needle biopsy takes tissue
from a small area, so there is a chance that a cancer may be missed.

What To Think About

Cancer that begins in the lymph nodes (lymphoma) is the most common form of cancer in teens
and young adults. Even though most enlarged lymph nodes are not caused by
lymphoma, it is important to have enlarged lymph nodes that do not go away
checked by your doctor.

Looking at a lymph node under a microscope
does not always give a clear diagnosis. In these cases, other tests are needed
to find the cause of the problem.

If an infection is present, a
culture of the lymph node may be done to find what is
causing the infection.

Sometimes a lymph node sample is treated
with special markers (antibodies) that attach to abnormal
cells. Marker studies may be done to find lymphomas and other types of
cancer.

Sentinel node biopsy may be done instead of removing an entire
group of lymph nodes. A sentinel node
is the first lymph node to which a certain cancer would travel. In some cases,
there may be more than one sentinel node. Sentinel node biopsy takes out less
tissue, and it does not cause as many problems with lymphedema.
To learn more, see the topic Sentinel Lymph Node Biopsy.

Some lymph node biopsies may be done using special tools in which
a thin lighted tube is used to take out a lymph node:

Laparoscopy
uses a lighted viewing scope (laparoscope) to look inside the belly and take a
biopsy of lymph nodes. It may be done to find cancer that has spread in the
belly. To learn more, see the topic
Laparoscopy.

Mediastinoscopy uses a
lighted viewing scope (mediastinoscope) to look inside the chest. The scope can
be used to take out samples of lymph nodes in the chest to see if lung cancer
has spread to the lymph nodes. To learn more, see the topic
Mediastinoscopy.

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